Management of Saphenous Vein Harvest Wound Complications Following Coronary Artery Bypass Grafting

Terry Treadwell, MD, FACS

Disclosures

Wounds. 2003;15(3) 

In This Article

Presentation

A 67-year-old African-American woman with insulin-dependent diabetes mellitus presented at the wound center with a left leg wound that extended from 9cm below the knee to just above the medial malleolus. History revealed the patient had undergone a coronary artery bypass grafting (CABG) operation one month prior to being seen at the wound center. Although the patient's sternal wound had healed uneventfully, the saphenous vein harvest incision in the left leg had not healed. The patient had not required the use of an intra-aortic balloon pump during or after her operation. She had no history of intra-operative or postoperative cardiac or vascular instability, infection, coagulation problems, or coumadin therapy. She had no history of diabetic peripheral neuropathy or diabetic foot problems. There was no history of pre-operative peripheral vascular evaluation.

At the time of her initial evaluation in the wound center, the patient's wound was necrotic throughout its entire length; the stitches were still in place. No arterial pulses were palpable at the ankle, but there was biphasic flow in the dorsalis pedis and posterior tibial arteries by Doppler. The ankle/brachial index was 0.65. No cellulitis or other problems were noted.

The patient was diagnosed with a nonhealing saphenous vain harvest incision following a CABG operation.

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